Sally, a 45-year-old female comes to see you in clinic today with what she describes as “an interesting issue”. She went camping with her husband 2 months ago and had a wonderful time; however, she was bit by a lone-star tick. She received immediate treatment in an urgent care center of doxycycline 100 mg po bid x 10 days, and thought everything was fine. Last night, Sally and her husband grilled big T-bone steaks and baked potatoes for dinner. Food she has always enjoyed. After eating the steak, she broke out in hives and had an episode of diarrhea. She has no residual symptoms this morning. Her assessment is totally normal. What is the best plan of care for Sally? 

Margo is a 58-year-old female who has been having syncopal symptoms for the past two months. She has a history of MI with 3 stents, HTN, DM II, and hyperlipidemia. She tells you that she as been more tired and short of breath with light activity to the point where during these episodes, she feels the world go gray as if she were about to pass out. Physical exam reveals moist oral mucous membranes, carotids without bruits bilaterally, LS CTA, S1S2 with grade III systolic murmur heard best at the 2nd ICS right sternal border, and CN II-XII intact. You order an ECG with the lead II showing below. What is your primary differential diagnosis?

The gray commissure is a space in the center of the spinal cord containing cerebrospinal fluid (CSF).

Which is most likely to be noted in a 45-year-old woman with laboratory evidence of chronic excessive alcohol ingestion?

ID: Which muscle is indicated by “D” in the image below?

Matching: Functional brain regions

You have agreed to help complete sports physicals for the local high school. Over 100 students came to the event and have been standing in long lines for the past few hours. When you go to bring the next student back, you notice a 18-year-old male that appears pale. He suddenly slumps to the floor and is unresponsive for 5 seconds but then begins to arouse. He is now alert and oriented x 4. His friend tells you that they got up really early this morning and ran 5 miles to prepare for cross country running. What should be your initial treatment?

Patient education is essential with your patient who you just diagnosed with infectious conjunctivitis. Which items should you share with your patient? Select all that apply. 

A 32-year-old woman has an exposure to HIV after a condom broke while having vaginal sex with her male partner who has HIV. She is unsure of his current viral load or whether he has been adherent to antiretroviral therapy. She did not seek care at that time but is now being seen 3 weeks later. Upon using a laboratory-based HIV-1/2 antigen-antibody immunoassay for follow-up HIV testing, which correct item of education should you share with the patient? 

ID: Which muscle is indicated by “B” in the image below?